5670. (a) It is the intent of the Legislature to encourage the
development of a system of residential treatment programs in every
county which provides a range of alternatives to institutional care
based on principles of residential, community-based treatment.
(b) It is further the intent of the Legislature that community
residential mental health programs in the State of California be
developed in accordance with the guidelines and principles set forth
in this chapter. To this end, counties may implement the community
residential treatment system described in this chapter either with
available county allocations, or as new moneys become available.
5670.5. Criteria for community residential treatment system
programs are as follows:
(a) Facilities:
(1) Settings, whether residential or day, should be as close to a
normal home environment as possible without sacrificing client safety
or care.
(2) Residential treatment centers should be relatively small,
preferably 15 beds or less, but in any case with the appearance of a
noninstitutional setting.
(3) The individual elements of the system should, where possible,
be in separate facilities, and not part of one large facility
attempting to serve an entire range of clients.
(b) Staffing patterns:
(1) Staffing patterns should reflect, to the maximum extent
feasible, at all levels, the cultural, linguistic, ethnic, sexual and
other social characteristics of the community the facility serves.
(2) The programs should be designed to use appropriate
multidisciplinary professional consultation and staff to meet the
specific diagnostic and treatment needs of the clients.
(3) The programs should use paraprofessionals and persons who have
been consumers of mental health services where appropriate.
(c) Programs:
(1) The programs should, to the maximum extent feasible, be
designed so as to reduce the dependence on medications as a sole
treatment tool. Programs in which prescriptions for medication are a
component of the program should be subject to the
medications-monitoring.
(2) The programs should have a rehabilitation focus which
encourages the client to develop the skills to become self-sufficient
and capable of increasing levels of independent functioning. Where
appropriate, they should include prevocational and vocational
programs.
(3) The program should encourage the participation of the clients
in the daily operation of the setting in development of treatment and
rehabilitation planning and evaluation.
(4) Participation in any element of the system should not preclude
the involvement of clients in individual therapy. Individual
therapists of clients should, where possible, be directly involved in
the development and implementation of a treatment plan, including
medication and day program decisions.
(d) Coordination:
The programs should demonstrate specific linkages with one
another, and with the general treatment and social service system, as
a whole. These connections should not be limited to the mental
health system, but should include, whenever possible, community
resources utilized by the general population.
5671. The following should be the programs in the community
residential treatment system. These programs should be designed to
provide, at every level, alternatives to institutional settings.
(a) A program for a short-term crisis residential alternative to
hospitalization for individuals experiencing an acute episode or
crisis requiring temporary removal from their home environment. The
program should be available for admissions 24 hours a day, seven days
a week. The primary focus of this program should be on reduction of
the crisis, on stabilization, and on a diagnostic assessment of the
person's existing support system, including recommendations for
referrals upon discharge.
The services in the program should include, but not be limited to,
provision for direct family work, connections to prevocational and
vocational programs, and development of a support system, including
income and treatment referrals. This program should be designed for
persons who would otherwise be referred to an inpatient unit, either
locally or in the state hospital. This program should place an
emphasis on stabilization and appropriate referral for further
treatment or support services, or both.
(b) A long-term residential treatment program, with a full day
treatment component as a part of the program, for persons who may
require intensive support for as long as two or three years. This
program should be designed to provide a rehabilitation program for
the so-called "chronic" patient who needs long-term support in order
to develop independent living skills. The clients in this program
should be those who would otherwise be living marginally in the
community with little or no service support, and who would return
many times to the hospital for treatment. It should also serve those
who are referred to, and maintained in, state hospitals or nursing
homes because they require long-term, intensive support. This program
should go beyond maintenance to provide an active rehabilitation
focus for these individuals.
The services in this program should include, but not be limited
to, intensive diagnostic work, including learning disability
assessment, full day treatment program with an active prevocational
and vocational component, special education services, outreach to
develop linkages with the general social service system, and
counseling to aid clients in developing the skills to move toward a
less structured setting.
(c) A transitional residential program designed for persons who
are able to take part in programs in the general community, but who,
without the support of counseling, as well as the therapeutic
community, would be at risk of returning to the hospital. This
program may employ a variety of staffing patterns and should be for
persons who may be expected to move toward a more independent living
setting within approximately three months to one year. The clients
should be expected to play a major role in the functioning of the
household, and shall be encouraged to accept increasing levels of
responsibility, both in the residential community, and in the
community as a whole. Residents should be required to be involved in
daytime activities outside of the house which are relevant to their
personal goals and conducive to their achieving more
self-sufficiency.
The services in this program should include, but are not limited
to, counseling and ongoing assessment, development of support systems
in the community, a day program which encourages interaction between
clients and the community-at-large, and an activity program that
encourages socialization and utilization of general community
resources.
(d) A program for semisupervised, independent, but structured
living arrangement for persons who do not need the intensive support
of the other system programs, but who, without some support and
structure, are at risk to return to a condition requiring
hospitalization. The individual apartments or houses should be shared
by three to five persons. These small cooperative housing units
should function as independent households with direct linkages to
staff support in case of emergencies, as well as for regular
assessment and evaluation meetings. Individuals may use satellite
housing as a transition to independent living, or may remain in this
setting indefinitely in order to avoid the need for more intensive
settings.
This program should be for persons who only need minimum support
in order to live in the community. These individuals may require rent
subsidy, as well as the backup of another system, in order to remain
in this setting. The satellite units should be as normative as the
general living arrangements in the communities in which they are
developed.
(e) A program to provide emergency housing or respite care
services, or both. These services should be designed for persons with
a mental disability in need of temporary housing, but who do not
require hospitalization or the more intensive support and treatment
of the crisis residential program. Services provided should include,
but not be limited to, advocacy, counseling, and linkages to
community mental health and other human services, including referrals
to vocational and housing opportunities.
(f) A day rehabilitation program which should be designed to
provide structured education, training, and support services to
promote the development of independent living skills and community
support. Services provided should include, but not be limited to,
peer support, education services, prevocational and employment
services, recreational and social activities, service brokerage and
advocacy, orientation to community resources, training in independent
living skills, health education including medication education,
individual and group counseling, education and counseling services
for family members, and crisis intervention.
(g) The program for socialization centers should be designed to
serve a broad range of clients, including those in the system
programs, when appropriate, as well as persons living in the
community in general. This program should be designed to provide
regular daytime, evening, and weekend activities for persons who
require long-term, structured support, but who do not receive such
services in their living setting. Although the socialization center
is meant to provide a maintenance support program for those
individuals who only wish or require regular socialization
opportunities, the programs should also provide the opportunity to
develop the skills to move toward more independent functioning.
The services in this program should include, but not be limited
to, outings, recreational activities, cultural events, linkages to
community resources, as well as prevocational counseling, life skills
training, and other rehabilitation efforts. This program should be
for persons who would lose contact with a social or treatment system,
or both, if left to their isolated living situation, or their
ability to participate in activities for the "general public." With
this level of support, persons would be able to lead full and active
lives, with the opportunity to develop the skills to move toward
independent living. Also included in the program should be adult
education support programs which utilize community college and other
adult education agencies. These services would provide opportunities
to individuals throughout the community residential treatment system
and in other living settings, including independent living, to
develop skills necessary for independent living through the
utilization of resources available to the general population.
(h) An in-home treatment program designed as an alternative to
out-of-home placement for individuals who are otherwise not
appropriate for, or do not choose to participate in, other elements
of the community residential treatment system. This program should be
designed for those individuals who would benefit most from a
treatment intervention in their home environment. It is a basic
premise of this element that treatment should focus on the
development of family and other personal and community supports,
rather than exclusively on the individual. The goal of the program
should be to reintegrate the individual with the family unit, when
appropriate, and with the greater community without removing the
person from his or her home environment.
The service may be designed as a crisis intervention for persons
experiencing an acute episode or an ongoing independent living
service, or both, for persons wishing to obtain or maintain housing
and services in the community. Services provided should include, but
not be limited to, crisis intervention, family work, when
appropriate, development of a specific treatment plan, development of
an ongoing rehabilitation plan utilizing available resources in the
community, and coordination with such services as case management,
vocational rehabilitation, schools and other education services, and
various special programs which would act as a support system for the
individual.
(i) A volunteer-based companion program designed to encourage the
development of personal relationships with residents of community
care facilities with the goal of motivating and assisting residents
to make a successful transition to independent living, or to programs
of the community residential treatment system.
The service should be provided primarily by volunteers, including
students as a part of a college or university curriculum, who are
supervised and coordinated by trained and experienced personnel.
Services provided should include, but not be limited to, recreation,
one-to-one companionship, advocacy, and assistance in developing the
knowledge and use of community resources, including housing and
vocational services, and follow up for persons who make the
transition to independent living.
5671.5. It is the intent of the Legislature that programs serving
children and adolescents should be established under this chapter.
Such programs should follow the guidelines and principles set forth
in this chapter and in addition should meet the following criteria
unique to the population to be served:
(a) The programs should, to the maximum extent feasible, be
designed so as to reduce the disruption and promote the reintegration
of the family unit of which the child is a part.
(b) The programs should have an education focus and should
demonstrate specific linkage with community education resources.
(c) The programs should contain a specific followup component.
5672. The types of programs serving children and adolescents
referred to in Section 5671.5 are those described in this section.
The programs should meet the criteria set forth in this section and
in Sections 5671 and 5671.5. Nothing in this section should be
construed to waive any licensure requirement pursuant to the
California Community Care Facilities Act (Chapter 3 (commencing with
Section 1500) of Division 2 of the Health and Safety Code) for any
community care facility.
(a) A program for a short-term crisis residential alternative to
hospitalization. The services in this program should include, but not
be limited to, provision of direct services to the family, specific
linkages with the child's educational system and community
educational resources, and development of a support system, including
school and treatment referrals. The program should be designed for
children and adolescents who would otherwise be referred to a
psychiatric inpatient unit. It should be a 24-hour program, with an
emphasis on stabilization and appropriate referral for further
treatment or support services.
(b) A long-term residential treatment program. This program should
have an educational orientation and should reflect the principle
that education be available in the least restrictive environment. The
program should serve children and adolescents requiring an intensive
support system for a period of six to 18 months, who would otherwise
be at risk of periodic hospitalization. The program should provide
coordinated intervention with the child, family unit, and community
education resources, and should include aftercare services to the
child and family unit to solidify gains and develop skills in linking
with community services.
(c) A transitional residential program. This program may include
group homes, foster homes, or homes adapted for preparing adolescents
approaching majority to adjust to emancipation.
The services in this program should include, but not be limited
to, coordination with community education resources to meet the child'
s individual need, family services designed to strengthen the family
unity of which the child is a part, and aftercare services to
reinforce the gains brought about by the program and assist in
community adjustment.
(d) A program for a semisupervised, independent but structured
living arrangement. This program should apply to older adolescents,
who are either emancipated or who would not be returning home from
out-of-home placement. The semisupervised living arrangement should
require structured living designed to impart those skills necessary
for successful independent living as described in subdivision (d) of
Section 5671. Adult supervision should be available 24 hours per day.
The services should include, but not be limited to, prevocational
and vocational linkages in the community, financial planning which
may include rent subsidy assistance, and development of a social
support system.
(e) (1) A day treatment program. This program should provide
services to children and adolescents who are residing in their own
homes or in out-of-home placements. Schoolsites or other
noninstitutional settings are preferred for this program. A day
treatment program for children should offer a multidisciplinary
approach and should incorporate education, recreation, and
rehabilitation activities. Services provided should be age
appropriate and age specific intensive remedial programs, including
education, counseling, socialization, and recreational services. To
the extent feasible, the client's family should be included in these
activities.
(2) Day treatment services should be designed to provide an
alternative to residential placement, to provide preventive services
in the early stages of family breakdown, and to reduce the need for
more costly and lengthy treatment services. Aftercare services should
be available to maintain gains and prevent family regression.
(f) A socialization center program. This program should provide a
multidisciplinary approach and seek funding from a variety of
agencies responsible for providing services, including, but not
limited to, school districts and recreation departments. The services
should promote community acceptance of clients and the integration
of their family units. Family involvement in planning activities and
developing support system linkages should be encouraged.
(g) An in-home treatment program. This program should be designed
to strengthen the child's ties with the family unit and with the
greater community without removing the child from his or her home
environment and community educational system.
Services provided should include, but not be limited to, crisis
intervention, direct family services, development of specific
treatment plans, development of ongoing plans utilizing available
resources in the community educational system, and special programs
which act as a support system for the child and family unit.
(h) Augmentation of crisis intervention program. This program
should provide specifically for evaluation, diagnosis, and
disposition planning for children and adolescents in psychiatric
crisis.
(i) Case management services program. This program should
emphasize prevention services and should be designed to divert to
noninstitutional programs children and adolescents at risk of
involvement with traditional mental health institutions.
5673. (a) A five-year pilot program is hereby authorized in Napa
County and Riverside County to establish a 15-bed locked facility in
each county, for the provision of community care and treatment for
mentally disordered persons who are placed in a state hospital or
another health facility because no community placements are available
to meet the needs of these patients. It is the intent of the
Legislature to carefully evaluate this specific approach to determine
its potential for replication in other limited jurisdictions.
Participation in this pilot program by the two counties shall be on a
voluntary basis. The pilot program shall be implemented
notwithstanding the following licensure requirements enforced by the
State Department of Social Services:
(1) Subdivision (a) of Section 1502 of the Health and Safety Code,
which defines a community care facility as providing nonmedical
care.
(2) Subdivision (a) of Section 1505 of the Health and Safety Code,
which exempts any health facility, as defined by Section 1250 of the
Health and Safety Code, from licensure under the California
Community Care Facilities Act (Chapter 3 (commencing with Section
1500) of Division 2 of the Health and Safety Code).
(3) Section 1507 of the Health and Safety Code, which limits the
provision of medical services in community care facilities to
incidental medical services.
(4) Paragraph (5) of subdivision (a) of Section 80001 of Title 22
of the California Code of Regulations, which states that an adult
residential facility provides nonmedical care.
(5) Paragraph (7) of subdivision (a) of Section 80072 of Title 22
of the California Code of Regulations, which relates to a client's
right not to be locked in any room, building, or facility premises.
However, for purposes of this section, a client shall not be locked
in any room.
(b) Clients provided care within these pilot facilities shall be
conservatees as defined by Section 5350 who, prior to the
establishment of this program, either received care at a state
hospital or were placed in facilities for the mentally disordered.
(c) Standards for services provided shall be developed by each
county mental health director, in consultation with, and approved by,
the State Department of Mental Health and monitored regularly by the
department for compliance with these standards. These services shall
be on a 24-hour basis in a therapeutic homelike environment. The
services shall cover the full range of the social rehabilitation
model concept, including, but not limited to, the following:
(1) Counseling.
(2) Day treatment.
(3) Crisis intervention.
(4) Vocational training.
(5) Medication evaluation and management by a licensed physician
and other licensed professional and paraprofessional staff who
possess a valid license or certificate to perform this function.
(d) Administration of medication and monitoring of medication
shall occur notwithstanding statutory and regulatory licensure
requirements for community care facilities to the contrary. Standards
for use of medications shall be developed and monitored by the State
Department of Mental Health.
(e) The facilities shall be licensed and monitored by the State
Department of Social Services and shall comply with all licensing
requirements except those specifically exempted by this section. In
addition, no less than 75 square feet of outdoor space per client
shall be made available for client use. The State Department of
Social Services shall conduct inspections of the facilities pursuant
to Section 1533 of the Health and Safety Code and shall be given
immediate access to the facilities.
(f) In staffing the pilot program, each county board of
supervisors shall give full consideration to each potential means of
implementation, including, but not limited to, the clinical,
programmatic, and economic benefits and advantages of each
alternative. The pilot program shall meet all of the staffing
criteria of subdivision (b) of Section 5670.5. The staff shall use
and document the actions of a multidisciplinary professional
consultation staff to meet the specific diagnostic and treatment
needs of clients. The staff shall include, but need not be limited
to, a licensed psychiatrist, a psychologist, a social worker, and a
psychiatric technician. The staff may also include a licensed
vocational nurse. One or more of the following licensed professionals
shall be present at the facility at all times:
(1) A psychiatrist or psychologist.
(2) A registered psychiatric nurse.
(3) A psychiatric technician.
(4) A licensed vocational nurse.
(g) Protocols and training shall be established for licensed
vocational nurses employed by these facilities.
(h) The State Department of Mental Health shall certify the
program content in each county and monitor the program's functions on
a regular basis and the State Department of Social Services shall
regularly evaluate the facilities in accord with its statutory and
regulatory licensure functions, pursuant to subdivisions (d) and (e).
(i) The pilot program shall be deemed successful if it
demonstrates both of the following:
(1) That costs of the program are no greater than public
expenditures for providing alternative services to the clients served
by the program.
(2) That the benefit to the clients, as described in subdivision
(h), is improved by the program.
(j) Commencement of the pilot program in each county pursuant to
this section shall be contingent upon the county and the department
identifying funds for this purpose, as described in a financial plan
that is approved in advance by the Department of Finance.
5675. (a) Subject to Section 5768, Placer County and up to 15 other
counties may establish a pilot project for up to six years, to
develop a shared mental health rehabilitation center for the
provision of community care and treatment for persons with mental
disorders who are placed in a state hospital or another health
facility because no community placements are available to meet the
needs of these patients. Participation in this pilot project by the
counties shall be on a voluntary basis.
(b) (1) The department shall establish, by emergency regulation,
the standards for the pilot project, and monitor the compliance of
the counties with those standards. Participating counties, in
consultation with the department, shall be responsible for program
monitoring.
(2) The department, in conjunction with the county mental health
directors, shall provide an interim report to the Legislature within
three years of the commencement of operation of the facilities
authorized pursuant to this section regarding the progress and cost
effectiveness demonstrated by the pilot project. The department, in
conjunction with the county mental health directors, shall report to
the Legislature within five years of the commencement of operation of
the facilities authorized pursuant to this section regarding the
progress and cost effectiveness demonstrated by the pilot project.
The report shall evaluate whether the pilot project is effective
based on clinical indicators, and is successful in preventing future
placement of its clients in state hospitals or other long-term health
facilities, and shall report whether the cost of care in the pilot
facilities is less than the cost of care in state hospitals or in
other long-term health facility options. The evaluation report shall
include, but not be limited to, an evaluation of the selected method
and the effectiveness of the pilot project staffing, and an analysis
of the effectiveness of the pilot project at meeting all of the
following objectives:
(A) That the clients placed in the facilities show improved global
assessment scores, as measured by preadmission and postadmission
tests.
(B) That the clients placed in the facilities demonstrate improved
functional behavior as measured by preadmission and postadmission
tests.
(C) That the clients placed in the facilities have reduced
medication levels as determined by comparison of preadmission and
postadmission records.
(3) The pilot project shall be deemed successful if it
demonstrates both of the following:
(A) The costs of the program are no greater than public
expenditures for providing alternative services to the clients served
by the project.
(B) That the benefit to the clients, as described in this
subdivision, is improved by the project.
(c) The project shall be subject to existing regulations of the
State Department of Health Services applicable to health facilities
that the State Department of Mental Health deems necessary for fire
and life safety of persons with mental illness.
(d) The department shall consider projects proposed by other
counties under Section 5768.
(e) (1) Clients served by the project shall have all of the
protections and rights guaranteed to mental health patients pursuant
to the following provisions of law:
(A) Part 1 (commencing with Section 5000) and this part.
(B) Article 5 (commencing with Section 835), Article 5.5
(commencing with Section 850), and Article 6 (commencing with Section
860) of Chapter 4 of Title 9 of the California Code of Regulations.
(2) Clients shall have access to the services of a county patients'
rights advocates as provided in Chapter 6.2 (commencing with Section
5500) of Part 1.
5675.1. (a) In accordance with subdivision (b), the department may
establish a system for the imposition of prompt and effective civil
sanctions for long-term care facilities licensed or certified by the
department, including facilities licensed under the provisions of
Sections 5675 and 5768, and including facilities certified as
providing a special treatment program under Sections 72443 to 72474,
inclusive, of Title 22 of the California Code of Regulations.
(b) If the department determines that there is or has been a
failure, in a substantial manner, on the part of any such facility to
comply with the applicable laws and regulations, the director may
impose the following sanctions:
(1) A plan of corrective action that addresses all failure
identified by the department and includes timelines for correction.
(2) A facility that is issued a plan of corrective action, and
that fails to comply with the plan and repeats the deficiency, may be
subject to immediate suspension of its license or certification,
until the deficiency is corrected, when failure to comply with the
plan of correction may cause a health or safety risk to residents.
(c) The department may also establish procedures for the appeal of
an administrative action taken pursuant to this section, including a
plan of corrective action or a suspension of license or
certification.
5675.2. (a) There is hereby created in the State Treasury the
Licensing and Certification Fund, Mental Health, from which money,
upon appropriation by the Legislature in the Budget Act, shall be
expended by the State Department of Mental Health to fund
administrative and other activities in support of the department's
Licensing and Certification Program.
(b) Commencing January 1, 2005, each new and renewal application
for a license to operate a mental health rehabilitation center shall
be accompanied by an application or renewal fee.
(c) The amount of the fees shall be determined and collected by
the State Department of Mental Health, but the total amount of the
fees collected shall not exceed the actual costs of licensure and
regulation of the centers, including, but not limited to, the costs
of processing the application, inspection costs, and other related
costs.
(d) Each license or renewal issued pursuant to this chapter shall
expire 12 months from the date of issuance. Application for renewal
of the license shall be accompanied by the necessary fee and shall be
filed with the department at least 30 days prior to the expiration
date. Failure to file a timely renewal may result in expiration of
the license.
(e) License and renewal fees collected pursuant to this section
shall be deposited into the Licensing and Certification Fund, Mental
Health.
(f) Fees collected by the department pursuant to this section
shall be expended by the department for the purpose of ensuring the
health and safety of all individuals providing care and supervision
by licensees and to support activities of the Licensing and
Certification Program, including, but not limited to, monitoring
facilities for compliance with applicable laws and regulations.
(g) The department may make additional charges to the facilities
if additional visits are required to ensure that corrective action is
taken by the licensee.
5676. (a) The department, in conjunction with the State Department
of Health Services, shall develop a state-level plan for a
streamlined and consolidated evaluation and monitoring program for
the review of skilled nursing facilities with special treatment
programs. The plan shall provide for consolidated reviews, reports,
and penalties for these facilities. The plan shall include the cost
of, and a timeline for implementing, the plan. The plan shall be
developed in consultation with stakeholders, including county mental
health programs, consumers, family members of persons residing in
long-term care facilities who have serious mental illness, and
long-term care providers. The plan shall review resident safety and
quality programming, ensure that long-term care facilities engaged
primarily in diagnosis, treatment, and care of persons with mental
diseases are available and appropriately evaluated, and ensure that
strong linkages are built to local communities and other treatment
resources for residents and their families. The plan shall be
submitted to the Legislature on or before March 1, 2001.
(b) The State Department of Health Services shall forward to the
State Department of Mental Health copies of citations issued to a
skilled nursing facility that has a special treatment program
certified by the State Department of Mental Health.
5676.5. (a) It is the intent of the Legislature to ensure that
funds allocated to establish or enhance mental health programs are
used to integrate the new or enhanced program into an existing system
of care.
(b) Counties that apply for funds to establish or enhance their
mental health service system shall document, in the application
process, how the new funds blend into an existing system of care and
do not supplant existing expenditures.
(c) Applications shall include plans for services and supports,
and shall specify how the new or enhanced program blends into an
existing array of services. Applications shall demonstrate how a
collaborative process involving clients, family members, and other
system stakeholders was used to develop the proposal.
(d) Applications shall include a commitment to outcome reporting,
as defined by the department, including client benefit outcomes,
client and family member satisfaction, system of care access, cost
savings, cost avoidance, and cost effectiveness outcomes that measure
both short- and long-term cost savings.
(e) Applications shall demonstrate, when appropriate, how the
county intends to continue the new or enhanced program when the grant
funds have ended.
5670. (a) It is the intent of the Legislature to encourage the
development of a system of residential treatment programs in every
county which provides a range of alternatives to institutional care
based on principles of residential, community-based treatment.
(b) It is further the intent of the Legislature that community
residential mental health programs in the State of California be
developed in accordance with the guidelines and principles set forth
in this chapter. To this end, counties may implement the community
residential treatment system described in this chapter either with
available county allocations, or as new moneys become available.
5670.5. Criteria for community residential treatment system
programs are as follows:
(a) Facilities:
(1) Settings, whether residential or day, should be as close to a
normal home environment as possible without sacrificing client safety
or care.
(2) Residential treatment centers should be relatively small,
preferably 15 beds or less, but in any case with the appearance of a
noninstitutional setting.
(3) The individual elements of the system should, where possible,
be in separate facilities, and not part of one large facility
attempting to serve an entire range of clients.
(b) Staffing patterns:
(1) Staffing patterns should reflect, to the maximum extent
feasible, at all levels, the cultural, linguistic, ethnic, sexual and
other social characteristics of the community the facility serves.
(2) The programs should be designed to use appropriate
multidisciplinary professional consultation and staff to meet the
specific diagnostic and treatment needs of the clients.
(3) The programs should use paraprofessionals and persons who have
been consumers of mental health services where appropriate.
(c) Programs:
(1) The programs should, to the maximum extent feasible, be
designed so as to reduce the dependence on medications as a sole
treatment tool. Programs in which prescriptions for medication are a
component of the program should be subject to the
medications-monitoring.
(2) The programs should have a rehabilitation focus which
encourages the client to develop the skills to become self-sufficient
and capable of increasing levels of independent functioning. Where
appropriate, they should include prevocational and vocational
programs.
(3) The program should encourage the participation of the clients
in the daily operation of the setting in development of treatment and
rehabilitation planning and evaluation.
(4) Participation in any element of the system should not preclude
the involvement of clients in individual therapy. Individual
therapists of clients should, where possible, be directly involved in
the development and implementation of a treatment plan, including
medication and day program decisions.
(d) Coordination:
The programs should demonstrate specific linkages with one
another, and with the general treatment and social service system, as
a whole. These connections should not be limited to the mental
health system, but should include, whenever possible, community
resources utilized by the general population.
5671. The following should be the programs in the community
residential treatment system. These programs should be designed to
provide, at every level, alternatives to institutional settings.
(a) A program for a short-term crisis residential alternative to
hospitalization for individuals experiencing an acute episode or
crisis requiring temporary removal from their home environment. The
program should be available for admissions 24 hours a day, seven days
a week. The primary focus of this program should be on reduction of
the crisis, on stabilization, and on a diagnostic assessment of the
person's existing support system, including recommendations for
referrals upon discharge.
The services in the program should include, but not be limited to,
provision for direct family work, connections to prevocational and
vocational programs, and development of a support system, including
income and treatment referrals. This program should be designed for
persons who would otherwise be referred to an inpatient unit, either
locally or in the state hospital. This program should place an
emphasis on stabilization and appropriate referral for further
treatment or support services, or both.
(b) A long-term residential treatment program, with a full day
treatment component as a part of the program, for persons who may
require intensive support for as long as two or three years. This
program should be designed to provide a rehabilitation program for
the so-called "chronic" patient who needs long-term support in order
to develop independent living skills. The clients in this program
should be those who would otherwise be living marginally in the
community with little or no service support, and who would return
many times to the hospital for treatment. It should also serve those
who are referred to, and maintained in, state hospitals or nursing
homes because they require long-term, intensive support. This program
should go beyond maintenance to provide an active rehabilitation
focus for these individuals.
The services in this program should include, but not be limited
to, intensive diagnostic work, including learning disability
assessment, full day treatment program with an active prevocational
and vocational component, special education services, outreach to
develop linkages with the general social service system, and
counseling to aid clients in developing the skills to move toward a
less structured setting.
(c) A transitional residential program designed for persons who
are able to take part in programs in the general community, but who,
without the support of counseling, as well as the therapeutic
community, would be at risk of returning to the hospital. This
program may employ a variety of staffing patterns and should be for
persons who may be expected to move toward a more independent living
setting within approximately three months to one year. The clients
should be expected to play a major role in the functioning of the
household, and shall be encouraged to accept increasing levels of
responsibility, both in the residential community, and in the
community as a whole. Residents should be required to be involved in
daytime activities outside of the house which are relevant to their
personal goals and conducive to their achieving more
self-sufficiency.
The services in this program should include, but are not limited
to, counseling and ongoing assessment, development of support systems
in the community, a day program which encourages interaction between
clients and the community-at-large, and an activity program that
encourages socialization and utilization of general community
resources.
(d) A program for semisupervised, independent, but structured
living arrangement for persons who do not need the intensive support
of the other system programs, but who, without some support and
structure, are at risk to return to a condition requiring
hospitalization. The individual apartments or houses should be shared
by three to five persons. These small cooperative housing units
should function as independent households with direct linkages to
staff support in case of emergencies, as well as for regular
assessment and evaluation meetings. Individuals may use satellite
housing as a transition to independent living, or may remain in this
setting indefinitely in order to avoid the need for more intensive
settings.
This program should be for persons who only need minimum support
in order to live in the community. These individuals may require rent
subsidy, as well as the backup of another system, in order to remain
in this setting. The satellite units should be as normative as the
general living arrangements in the communities in which they are
developed.
(e) A program to provide emergency housing or respite care
services, or both. These services should be designed for persons with
a mental disability in need of temporary housing, but who do not
require hospitalization or the more intensive support and treatment
of the crisis residential program. Services provided should include,
but not be limited to, advocacy, counseling, and linkages to
community mental health and other human services, including referrals
to vocational and housing opportunities.
(f) A day rehabilitation program which should be designed to
provide structured education, training, and support services to
promote the development of independent living skills and community
support. Services provided should include, but not be limited to,
peer support, education services, prevocational and employment
services, recreational and social activities, service brokerage and
advocacy, orientation to community resources, training in independent
living skills, health education including medication education,
individual and group counseling, education and counseling services
for family members, and crisis intervention.
(g) The program for socialization centers should be designed to
serve a broad range of clients, including those in the system
programs, when appropriate, as well as persons living in the
community in general. This program should be designed to provide
regular daytime, evening, and weekend activities for persons who
require long-term, structured support, but who do not receive such
services in their living setting. Although the socialization center
is meant to provide a maintenance support program for those
individuals who only wish or require regular socialization
opportunities, the programs should also provide the opportunity to
develop the skills to move toward more independent functioning.
The services in this program should include, but not be limited
to, outings, recreational activities, cultural events, linkages to
community resources, as well as prevocational counseling, life skills
training, and other rehabilitation efforts. This program should be
for persons who would lose contact with a social or treatment system,
or both, if left to their isolated living situation, or their
ability to participate in activities for the "general public." With
this level of support, persons would be able to lead full and active
lives, with the opportunity to develop the skills to move toward
independent living. Also included in the program should be adult
education support programs which utilize community college and other
adult education agencies. These services would provide opportunities
to individuals throughout the community residential treatment system
and in other living settings, including independent living, to
develop skills necessary for independent living through the
utilization of resources available to the general population.
(h) An in-home treatment program designed as an alternative to
out-of-home placement for individuals who are otherwise not
appropriate for, or do not choose to participate in, other elements
of the community residential treatment system. This program should be
designed for those individuals who would benefit most from a
treatment intervention in their home environment. It is a basic
premise of this element that treatment should focus on the
development of family and other personal and community supports,
rather than exclusively on the individual. The goal of the program
should be to reintegrate the individual with the family unit, when
appropriate, and with the greater community without removing the
person from his or her home environment.
The service may be designed as a crisis intervention for persons
experiencing an acute episode or an ongoing independent living
service, or both, for persons wishing to obtain or maintain housing
and services in the community. Services provided should include, but
not be limited to, crisis intervention, family work, when
appropriate, development of a specific treatment plan, development of
an ongoing rehabilitation plan utilizing available resources in the
community, and coordination with such services as case management,
vocational rehabilitation, schools and other education services, and
various special programs which would act as a support system for the
individual.
(i) A volunteer-based companion program designed to encourage the
development of personal relationships with residents of community
care facilities with the goal of motivating and assisting residents
to make a successful transition to independent living, or to programs
of the community residential treatment system.
The service should be provided primarily by volunteers, including
students as a part of a college or university curriculum, who are
supervised and coordinated by trained and experienced personnel.
Services provided should include, but not be limited to, recreation,
one-to-one companionship, advocacy, and assistance in developing the
knowledge and use of community resources, including housing and
vocational services, and follow up for persons who make the
transition to independent living.
5671.5. It is the intent of the Legislature that programs serving
children and adolescents should be established under this chapter.
Such programs should follow the guidelines and principles set forth
in this chapter and in addition should meet the following criteria
unique to the population to be served:
(a) The programs should, to the maximum extent feasible, be
designed so as to reduce the disruption and promote the reintegration
of the family unit of which the child is a part.
(b) The programs should have an education focus and should
demonstrate specific linkage with community education resources.
(c) The programs should contain a specific followup component.
5672. The types of programs serving children and adolescents
referred to in Section 5671.5 are those described in this section.
The programs should meet the criteria set forth in this section and
in Sections 5671 and 5671.5. Nothing in this section should be
construed to waive any licensure requirement pursuant to the
California Community Care Facilities Act (Chapter 3 (commencing with
Section 1500) of Division 2 of the Health and Safety Code) for any
community care facility.
(a) A program for a short-term crisis residential alternative to
hospitalization. The services in this program should include, but not
be limited to, provision of direct services to the family, specific
linkages with the child's educational system and community
educational resources, and development of a support system, including
school and treatment referrals. The program should be designed for
children and adolescents who would otherwise be referred to a
psychiatric inpatient unit. It should be a 24-hour program, with an
emphasis on stabilization and appropriate referral for further
treatment or support services.
(b) A long-term residential treatment program. This program should
have an educational orientation and should reflect the principle
that education be available in the least restrictive environment. The
program should serve children and adolescents requiring an intensive
support system for a period of six to 18 months, who would otherwise
be at risk of periodic hospitalization. The program should provide
coordinated intervention with the child, family unit, and community
education resources, and should include aftercare services to the
child and family unit to solidify gains and develop skills in linking
with community services.
(c) A transitional residential program. This program may include
group homes, foster homes, or homes adapted for preparing adolescents
approaching majority to adjust to emancipation.
The services in this program should include, but not be limited
to, coordination with community education resources to meet the child'
s individual need, family services designed to strengthen the family
unity of which the child is a part, and aftercare services to
reinforce the gains brought about by the program and assist in
community adjustment.
(d) A program for a semisupervised, independent but structured
living arrangement. This program should apply to older adolescents,
who are either emancipated or who would not be returning home from
out-of-home placement. The semisupervised living arrangement should
require structured living designed to impart those skills necessary
for successful independent living as described in subdivision (d) of
Section 5671. Adult supervision should be available 24 hours per day.
The services should include, but not be limited to, prevocational
and vocational linkages in the community, financial planning which
may include rent subsidy assistance, and development of a social
support system.
(e) (1) A day treatment program. This program should provide
services to children and adolescents who are residing in their own
homes or in out-of-home placements. Schoolsites or other
noninstitutional settings are preferred for this program. A day
treatment program for children should offer a multidisciplinary
approach and should incorporate education, recreation, and
rehabilitation activities. Services provided should be age
appropriate and age specific intensive remedial programs, including
education, counseling, socialization, and recreational services. To
the extent feasible, the client's family should be included in these
activities.
(2) Day treatment services should be designed to provide an
alternative to residential placement, to provide preventive services
in the early stages of family breakdown, and to reduce the need for
more costly and lengthy treatment services. Aftercare services should
be available to maintain gains and prevent family regression.
(f) A socialization center program. This program should provide a
multidisciplinary approach and seek funding from a variety of
agencies responsible for providing services, including, but not
limited to, school districts and recreation departments. The services
should promote community acceptance of clients and the integration
of their family units. Family involvement in planning activities and
developing support system linkages should be encouraged.
(g) An in-home treatment program. This program should be designed
to strengthen the child's ties with the family unit and with the
greater community without removing the child from his or her home
environment and community educational system.
Services provided should include, but not be limited to, crisis
intervention, direct family services, development of specific
treatment plans, development of ongoing plans utilizing available
resources in the community educational system, and special programs
which act as a support system for the child and family unit.
(h) Augmentation of crisis intervention program. This program
should provide specifically for evaluation, diagnosis, and
disposition planning for children and adolescents in psychiatric
crisis.
(i) Case management services program. This program should
emphasize prevention services and should be designed to divert to
noninstitutional programs children and adolescents at risk of
involvement with traditional mental health institutions.
5673. (a) A five-year pilot program is hereby authorized in Napa
County and Riverside County to establish a 15-bed locked facility in
each county, for the provision of community care and treatment for
mentally disordered persons who are placed in a state hospital or
another health facility because no community placements are available
to meet the needs of these patients. It is the intent of the
Legislature to carefully evaluate this specific approach to determine
its potential for replication in other limited jurisdictions.
Participation in this pilot program by the two counties shall be on a
voluntary basis. The pilot program shall be implemented
notwithstanding the following licensure requirements enforced by the
State Department of Social Services:
(1) Subdivision (a) of Section 1502 of the Health and Safety Code,
which defines a community care facility as providing nonmedical
care.
(2) Subdivision (a) of Section 1505 of the Health and Safety Code,
which exempts any health facility, as defined by Section 1250 of the
Health and Safety Code, from licensure under the California
Community Care Facilities Act (Chapter 3 (commencing with Section
1500) of Division 2 of the Health and Safety Code).
(3) Section 1507 of the Health and Safety Code, which limits the
provision of medical services in community care facilities to
incidental medical services.
(4) Paragraph (5) of subdivision (a) of Section 80001 of Title 22
of the California Code of Regulations, which states that an adult
residential facility provides nonmedical care.
(5) Paragraph (7) of subdivision (a) of Section 80072 of Title 22
of the California Code of Regulations, which relates to a client's
right not to be locked in any room, building, or facility premises.
However, for purposes of this section, a client shall not be locked
in any room.
(b) Clients provided care within these pilot facilities shall be
conservatees as defined by Section 5350 who, prior to the
establishment of this program, either received care at a state
hospital or were placed in facilities for the mentally disordered.
(c) Standards for services provided shall be developed by each
county mental health director, in consultation with, and approved by,
the State Department of Mental Health and monitored regularly by the
department for compliance with these standards. These services shall
be on a 24-hour basis in a therapeutic homelike environment. The
services shall cover the full range of the social rehabilitation
model concept, including, but not limited to, the following:
(1) Counseling.
(2) Day treatment.
(3) Crisis intervention.
(4) Vocational training.
(5) Medication evaluation and management by a licensed physician
and other licensed professional and paraprofessional staff who
possess a valid license or certificate to perform this function.
(d) Administration of medication and monitoring of medication
shall occur notwithstanding statutory and regulatory licensure
requirements for community care facilities to the contrary. Standards
for use of medications shall be developed and monitored by the State
Department of Mental Health.
(e) The facilities shall be licensed and monitored by the State
Department of Social Services and shall comply with all licensing
requirements except those specifically exempted by this section. In
addition, no less than 75 square feet of outdoor space per client
shall be made available for client use. The State Department of
Social Services shall conduct inspections of the facilities pursuant
to Section 1533 of the Health and Safety Code and shall be given
immediate access to the facilities.
(f) In staffing the pilot program, each county board of
supervisors shall give full consideration to each potential means of
implementation, including, but not limited to, the clinical,
programmatic, and economic benefits and advantages of each
alternative. The pilot program shall meet all of the staffing
criteria of subdivision (b) of Section 5670.5. The staff shall use
and document the actions of a multidisciplinary professional
consultation staff to meet the specific diagnostic and treatment
needs of clients. The staff shall include, but need not be limited
to, a licensed psychiatrist, a psychologist, a social worker, and a
psychiatric technician. The staff may also include a licensed
vocational nurse. One or more of the following licensed professionals
shall be present at the facility at all times:
(1) A psychiatrist or psychologist.
(2) A registered psychiatric nurse.
(3) A psychiatric technician.
(4) A licensed vocational nurse.
(g) Protocols and training shall be established for licensed
vocational nurses employed by these facilities.
(h) The State Department of Mental Health shall certify the
program content in each county and monitor the program's functions on
a regular basis and the State Department of Social Services shall
regularly evaluate the facilities in accord with its statutory and
regulatory licensure functions, pursuant to subdivisions (d) and (e).
(i) The pilot program shall be deemed successful if it
demonstrates both of the following:
(1) That costs of the program are no greater than public
expenditures for providing alternative services to the clients served
by the program.
(2) That the benefit to the clients, as described in subdivision
(h), is improved by the program.
(j) Commencement of the pilot program in each county pursuant to
this section shall be contingent upon the county and the department
identifying funds for this purpose, as described in a financial plan
that is approved in advance by the Department of Finance.
5675. (a) Subject to Section 5768, Placer County and up to 15 other
counties may establish a pilot project for up to six years, to
develop a shared mental health rehabilitation center for the
provision of community care and treatment for persons with mental
disorders who are placed in a state hospital or another health
facility because no community placements are available to meet the
needs of these patients. Participation in this pilot project by the
counties shall be on a voluntary basis.
(b) (1) The department shall establish, by emergency regulation,
the standards for the pilot project, and monitor the compliance of
the counties with those standards. Participating counties, in
consultation with the department, shall be responsible for program
monitoring.
(2) The department, in conjunction with the county mental health
directors, shall provide an interim report to the Legislature within
three years of the commencement of operation of the facilities
authorized pursuant to this section regarding the progress and cost
effectiveness demonstrated by the pilot project. The department, in
conjunction with the county mental health directors, shall report to
the Legislature within five years of the commencement of operation of
the facilities authorized pursuant to this section regarding the
progress and cost effectiveness demonstrated by the pilot project.
The report shall evaluate whether the pilot project is effective
based on clinical indicators, and is successful in preventing future
placement of its clients in state hospitals or other long-term health
facilities, and shall report whether the cost of care in the pilot
facilities is less than the cost of care in state hospitals or in
other long-term health facility options. The evaluation report shall
include, but not be limited to, an evaluation of the selected method
and the effectiveness of the pilot project staffing, and an analysis
of the effectiveness of the pilot project at meeting all of the
following objectives:
(A) That the clients placed in the facilities show improved global
assessment scores, as measured by preadmission and postadmission
tests.
(B) That the clients placed in the facilities demonstrate improved
functional behavior as measured by preadmission and postadmission
tests.
(C) That the clients placed in the facilities have reduced
medication levels as determined by comparison of preadmission and
postadmission records.
(3) The pilot project shall be deemed successful if it
demonstrates both of the following:
(A) The costs of the program are no greater than public
expenditures for providing alternative services to the clients served
by the project.
(B) That the benefit to the clients, as described in this
subdivision, is improved by the project.
(c) The project shall be subject to existing regulations of the
State Department of Health Services applicable to health facilities
that the State Department of Mental Health deems necessary for fire
and life safety of persons with mental illness.
(d) The department shall consider projects proposed by other
counties under Section 5768.
(e) (1) Clients served by the project shall have all of the
protections and rights guaranteed to mental health patients pursuant
to the following provisions of law:
(A) Part 1 (commencing with Section 5000) and this part.
(B) Article 5 (commencing with Section 835), Article 5.5
(commencing with Section 850), and Article 6 (commencing with Section
860) of Chapter 4 of Title 9 of the California Code of Regulations.
(2) Clients shall have access to the services of a county patients'
rights advocates as provided in Chapter 6.2 (commencing with Section
5500) of Part 1.
5675.1. (a) In accordance with subdivision (b), the department may
establish a system for the imposition of prompt and effective civil
sanctions for long-term care facilities licensed or certified by the
department, including facilities licensed under the provisions of
Sections 5675 and 5768, and including facilities certified as
providing a special treatment program under Sections 72443 to 72474,
inclusive, of Title 22 of the California Code of Regulations.
(b) If the department determines that there is or has been a
failure, in a substantial manner, on the part of any such facility to
comply with the applicable laws and regulations, the director may
impose the following sanctions:
(1) A plan of corrective action that addresses all failure
identified by the department and includes timelines for correction.
(2) A facility that is issued a plan of corrective action, and
that fails to comply with the plan and repeats the deficiency, may be
subject to immediate suspension of its license or certification,
until the deficiency is corrected, when failure to comply with the
plan of correction may cause a health or safety risk to residents.
(c) The department may also establish procedures for the appeal of
an administrative action taken pursuant to this section, including a
plan of corrective action or a suspension of license or
certification.
5675.2. (a) There is hereby created in the State Treasury the
Licensing and Certification Fund, Mental Health, from which money,
upon appropriation by the Legislature in the Budget Act, shall be
expended by the State Department of Mental Health to fund
administrative and other activities in support of the department's
Licensing and Certification Program.
(b) Commencing January 1, 2005, each new and renewal application
for a license to operate a mental health rehabilitation center shall
be accompanied by an application or renewal fee.
(c) The amount of the fees shall be determined and collected by
the State Department of Mental Health, but the total amount of the
fees collected shall not exceed the actual costs of licensure and
regulation of the centers, including, but not limited to, the costs
of processing the application, inspection costs, and other related
costs.
(d) Each license or renewal issued pursuant to this chapter shall
expire 12 months from the date of issuance. Application for renewal
of the license shall be accompanied by the necessary fee and shall be
filed with the department at least 30 days prior to the expiration
date. Failure to file a timely renewal may result in expiration of
the license.
(e) License and renewal fees collected pursuant to this section
shall be deposited into the Licensing and Certification Fund, Mental
Health.
(f) Fees collected by the department pursuant to this section
shall be expended by the department for the purpose of ensuring the
health and safety of all individuals providing care and supervision
by licensees and to support activities of the Licensing and
Certification Program, including, but not limited to, monitoring
facilities for compliance with applicable laws and regulations.
(g) The department may make additional charges to the facilities
if additional visits are required to ensure that corrective action is
taken by the licensee.
5676. (a) The department, in conjunction with the State Department
of Health Services, shall develop a state-level plan for a
streamlined and consolidated evaluation and monitoring program for
the review of skilled nursing facilities with special treatment
programs. The plan shall provide for consolidated reviews, reports,
and penalties for these facilities. The plan shall include the cost
of, and a timeline for implementing, the plan. The plan shall be
developed in consultation with stakeholders, including county mental
health programs, consumers, family members of persons residing in
long-term care facilities who have serious mental illness, and
long-term care providers. The plan shall review resident safety and
quality programming, ensure that long-term care facilities engaged
primarily in diagnosis, treatment, and care of persons with mental
diseases are available and appropriately evaluated, and ensure that
strong linkages are built to local communities and other treatment
resources for residents and their families. The plan shall be
submitted to the Legislature on or before March 1, 2001.
(b) The State Department of Health Services shall forward to the
State Department of Mental Health copies of citations issued to a
skilled nursing facility that has a special treatment program
certified by the State Department of Mental Health.
5676.5. (a) It is the intent of the Legislature to ensure that
funds allocated to establish or enhance mental health programs are
used to integrate the new or enhanced program into an existing system
of care.
(b) Counties that apply for funds to establish or enhance their
mental health service system shall document, in the application
process, how the new funds blend into an existing system of care and
do not supplant existing expenditures.
(c) Applications shall include plans for services and supports,
and shall specify how the new or enhanced program blends into an
existing array of services. Applications shall demonstrate how a
collaborative process involving clients, family members, and other
system stakeholders was used to develop the proposal.
(d) Applications shall include a commitment to outcome reporting,
as defined by the department, including client benefit outcomes,
client and family member satisfaction, system of care access, cost
savings, cost avoidance, and cost effectiveness outcomes that measure
both short- and long-term cost savings.
(e) Applications shall demonstrate, when appropriate, how the
county intends to continue the new or enhanced program when the grant
funds have ended.
5670. (a) It is the intent of the Legislature to encourage the
development of a system of residential treatment programs in every
county which provides a range of alternatives to institutional care
based on principles of residential, community-based treatment.
(b) It is further the intent of the Legislature that community
residential mental health programs in the State of California be
developed in accordance with the guidelines and principles set forth
in this chapter. To this end, counties may implement the community
residential treatment system described in this chapter either with
available county allocations, or as new moneys become available.
5670.5. Criteria for community residential treatment system
programs are as follows:
(a) Facilities:
(1) Settings, whether residential or day, should be as close to a
normal home environment as possible without sacrificing client safety
or care.
(2) Residential treatment centers should be relatively small,
preferably 15 beds or less, but in any case with the appearance of a
noninstitutional setting.
(3) The individual elements of the system should, where possible,
be in separate facilities, and not part of one large facility
attempting to serve an entire range of clients.
(b) Staffing patterns:
(1) Staffing patterns should reflect, to the maximum extent
feasible, at all levels, the cultural, linguistic, ethnic, sexual and
other social characteristics of the community the facility serves.
(2) The programs should be designed to use appropriate
multidisciplinary professional consultation and staff to meet the
specific diagnostic and treatment needs of the clients.
(3) The programs should use paraprofessionals and persons who have
been consumers of mental health services where appropriate.
(c) Programs:
(1) The programs should, to the maximum extent feasible, be
designed so as to reduce the dependence on medications as a sole
treatment tool. Programs in which prescriptions for medication are a
component of the program should be subject to the
medications-monitoring.
(2) The programs should have a rehabilitation focus which
encourages the client to develop the skills to become self-sufficient
and capable of increasing levels of independent functioning. Where
appropriate, they should include prevocational and vocational
programs.
(3) The program should encourage the participation of the clients
in the daily operation of the setting in development of treatment and
rehabilitation planning and evaluation.
(4) Participation in any element of the system should not preclude
the involvement of clients in individual therapy. Individual
therapists of clients should, where possible, be directly involved in
the development and implementation of a treatment plan, including
medication and day program decisions.
(d) Coordination:
The programs should demonstrate specific linkages with one
another, and with the general treatment and social service system, as
a whole. These connections should not be limited to the mental
health system, but should include, whenever possible, community
resources utilized by the general population.
5671. The following should be the programs in the community
residential treatment system. These programs should be designed to
provide, at every level, alternatives to institutional settings.
(a) A program for a short-term crisis residential alternative to
hospitalization for individuals experiencing an acute episode or
crisis requiring temporary removal from their home environment. The
program should be available for admissions 24 hours a day, seven days
a week. The primary focus of this program should be on reduction of
the crisis, on stabilization, and on a diagnostic assessment of the
person's existing support system, including recommendations for
referrals upon discharge.
The services in the program should include, but not be limited to,
provision for direct family work, connections to prevocational and
vocational programs, and development of a support system, including
income and treatment referrals. This program should be designed for
persons who would otherwise be referred to an inpatient unit, either
locally or in the state hospital. This program should place an
emphasis on stabilization and appropriate referral for further
treatment or support services, or both.
(b) A long-term residential treatment program, with a full day
treatment component as a part of the program, for persons who may
require intensive support for as long as two or three years. This
program should be designed to provide a rehabilitation program for
the so-called "chronic" patient who needs long-term support in order
to develop independent living skills. The clients in this program
should be those who would otherwise be living marginally in the
community with little or no service support, and who would return
many times to the hospital for treatment. It should also serve those
who are referred to, and maintained in, state hospitals or nursing
homes because they require long-term, intensive support. This program
should go beyond maintenance to provide an active rehabilitation
focus for these individuals.
The services in this program should include, but not be limited
to, intensive diagnostic work, including learning disability
assessment, full day treatment program with an active prevocational
and vocational component, special education services, outreach to
develop linkages with the general social service system, and
counseling to aid clients in developing the skills to move toward a
less structured setting.
(c) A transitional residential program designed for persons who
are able to take part in programs in the general community, but who,
without the support of counseling, as well as the therapeutic
community, would be at risk of returning to the hospital. This
program may employ a variety of staffing patterns and should be for
persons who may be expected to move toward a more independent living
setting within approximately three months to one year. The clients
should be expected to play a major role in the functioning of the
household, and shall be encouraged to accept increasing levels of
responsibility, both in the residential community, and in the
community as a whole. Residents should be required to be involved in
daytime activities outside of the house which are relevant to their
personal goals and conducive to their achieving more
self-sufficiency.
The services in this program should include, but are not limited
to, counseling and ongoing assessment, development of support systems
in the community, a day program which encourages interaction between
clients and the community-at-large, and an activity program that
encourages socialization and utilization of general community
resources.
(d) A program for semisupervised, independent, but structured
living arrangement for persons who do not need the intensive support
of the other system programs, but who, without some support and
structure, are at risk to return to a condition requiring
hospitalization. The individual apartments or houses should be shared
by three to five persons. These small cooperative housing units
should function as independent households with direct linkages to
staff support in case of emergencies, as well as for regular
assessment and evaluation meetings. Individuals may use satellite
housing as a transition to independent living, or may remain in this
setting indefinitely in order to avoid the need for more intensive
settings.
This program should be for persons who only need minimum support
in order to live in the community. These individuals may require rent
subsidy, as well as the backup of another system, in order to remain
in this setting. The satellite units should be as normative as the
general living arrangements in the communities in which they are
developed.
(e) A program to provide emergency housing or respite care
services, or both. These services should be designed for persons with
a mental disability in need of temporary housing, but who do not
require hospitalization or the more intensive support and treatment
of the crisis residential program. Services provided should include,
but not be limited to, advocacy, counseling, and linkages to
community mental health and other human services, including referrals
to vocational and housing opportunities.
(f) A day rehabilitation program which should be designed to
provide structured education, training, and support services to
promote the development of independent living skills and community
support. Services provided should include, but not be limited to,
peer support, education services, prevocational and employment
services, recreational and social activities, service brokerage and
advocacy, orientation to community resources, training in independent
living skills, health education including medication education,
individual and group counseling, education and counseling services
for family members, and crisis intervention.
(g) The program for socialization centers should be designed to
serve a broad range of clients, including those in the system
programs, when appropriate, as well as persons living in the
community in general. This program should be designed to provide
regular daytime, evening, and weekend activities for persons who
require long-term, structured support, but who do not receive such
services in their living setting. Although the socialization center
is meant to provide a maintenance support program for those
individuals who only wish or require regular socialization
opportunities, the programs should also provide the opportunity to
develop the skills to move toward more independent functioning.
The services in this program should include, but not be limited
to, outings, recreational activities, cultural events, linkages to
community resources, as well as prevocational counseling, life skills
training, and other rehabilitation efforts. This program should be
for persons who would lose contact with a social or treatment system,
or both, if left to their isolated living situation, or their
ability to participate in activities for the "general public." With
this level of support, persons would be able to lead full and active
lives, with the opportunity to develop the skills to move toward
independent living. Also included in the program should be adult
education support programs which utilize community college and other
adult education agencies. These services would provide opportunities
to individuals throughout the community residential treatment system
and in other living settings, including independent living, to
develop skills necessary for independent living through the
utilization of resources available to the general population.
(h) An in-home treatment program designed as an alternative to
out-of-home placement for individuals who are otherwise not
appropriate for, or do not choose to participate in, other elements
of the community residential treatment system. This program should be
designed for those individuals who would benefit most from a
treatment intervention in their home environment. It is a basic
premise of this element that treatment should focus on the
development of family and other personal and community supports,
rather than exclusively on the individual. The goal of the program
should be to reintegrate the individual with the family unit, when
appropriate, and with the greater community without removing the
person from his or her home environment.
The service may be designed as a crisis intervention for persons
experiencing an acute episode or an ongoing independent living
service, or both, for persons wishing to obtain or maintain housing
and services in the community. Services provided should include, but
not be limited to, crisis intervention, family work, when
appropriate, development of a specific treatment plan, development of
an ongoing rehabilitation plan utilizing available resources in the
community, and coordination with such services as case management,
vocational rehabilitation, schools and other education services, and
various special programs which would act as a support system for the
individual.
(i) A volunteer-based companion program designed to encourage the
development of personal relationships with residents of community
care facilities with the goal of motivating and assisting residents
to make a successful transition to independent living, or to programs
of the community residential treatment system.
The service should be provided primarily by volunteers, including
students as a part of a college or university curriculum, who are
supervised and coordinated by trained and experienced personnel.
Services provided should include, but not be limited to, recreation,
one-to-one companionship, advocacy, and assistance in developing the
knowledge and use of community resources, including housing and
vocational services, and follow up for persons who make the
transition to independent living.
5671.5. It is the intent of the Legislature that programs serving
children and adolescents should be established under this chapter.
Such programs should follow the guidelines and principles set forth
in this chapter and in addition should meet the following criteria
unique to the population to be served:
(a) The programs should, to the maximum extent feasible, be
designed so as to reduce the disruption and promote the reintegration
of the family unit of which the child is a part.
(b) The programs should have an education focus and should
demonstrate specific linkage with community education resources.
(c) The programs should contain a specific followup component.
5672. The types of programs serving children and adolescents
referred to in Section 5671.5 are those described in this section.
The programs should meet the criteria set forth in this section and
in Sections 5671 and 5671.5. Nothing in this section should be
construed to waive any licensure requirement pursuant to the
California Community Care Facilities Act (Chapter 3 (commencing with
Section 1500) of Division 2 of the Health and Safety Code) for any
community care facility.
(a) A program for a short-term crisis residential alternative to
hospitalization. The services in this program should include, but not
be limited to, provision of direct services to the family, specific
linkages with the child's educational system and community
educational resources, and development of a support system, including
school and treatment referrals. The program should be designed for
children and adolescents who would otherwise be referred to a
psychiatric inpatient unit. It should be a 24-hour program, with an
emphasis on stabilization and appropriate referral for further
treatment or support services.
(b) A long-term residential treatment program. This program should
have an educational orientation and should reflect the principle
that education be available in the least restrictive environment. The
program should serve children and adolescents requiring an intensive
support system for a period of six to 18 months, who would otherwise
be at risk of periodic hospitalization. The program should provide
coordinated intervention with the child, family unit, and community
education resources, and should include aftercare services to the
child and family unit to solidify gains and develop skills in linking
with community services.
(c) A transitional residential program. This program may include
group homes, foster homes, or homes adapted for preparing adolescents
approaching majority to adjust to emancipation.
The services in this program should include, but not be limited
to, coordination with community education resources to meet the child'
s individual need, family services designed to strengthen the family
unity of which the child is a part, and aftercare services to
reinforce the gains brought about by the program and assist in
community adjustment.
(d) A program for a semisupervised, independent but structured
living arrangement. This program should apply to older adolescents,
who are either emancipated or who would not be returning home from
out-of-home placement. The semisupervised living arrangement should
require structured living designed to impart those skills necessary
for successful independent living as described in subdivision (d) of
Section 5671. Adult supervision should be available 24 hours per day.
The services should include, but not be limited to, prevocational
and vocational linkages in the community, financial planning which
may include rent subsidy assistance, and development of a social
support system.
(e) (1) A day treatment program. This program should provide
services to children and adolescents who are residing in their own
homes or in out-of-home placements. Schoolsites or other
noninstitutional settings are preferred for this program. A day
treatment program for children should offer a multidisciplinary
approach and should incorporate education, recreation, and
rehabilitation activities. Services provided should be age
appropriate and age specific intensive remedial programs, including
education, counseling, socialization, and recreational services. To
the extent feasible, the client's family should be included in these
activities.
(2) Day treatment services should be designed to provide an
alternative to residential placement, to provide preventive services
in the early stages of family breakdown, and to reduce the need for
more costly and lengthy treatment services. Aftercare services should
be available to maintain gains and prevent family regression.
(f) A socialization center program. This program should provide a
multidisciplinary approach and seek funding from a variety of
agencies responsible for providing services, including, but not
limited to, school districts and recreation departments. The services
should promote community acceptance of clients and the integration
of their family units. Family involvement in planning activities and
developing support system linkages should be encouraged.
(g) An in-home treatment program. This program should be designed
to strengthen the child's ties with the family unit and with the
greater community without removing the child from his or her home
environment and community educational system.
Services provided should include, but not be limited to, crisis
intervention, direct family services, development of specific
treatment plans, development of ongoing plans utilizing available
resources in the community educational system, and special programs
which act as a support system for the child and family unit.
(h) Augmentation of crisis intervention program. This program
should provide specifically for evaluation, diagnosis, and
disposition planning for children and adolescents in psychiatric
crisis.
(i) Case management services program. This program should
emphasize prevention services and should be designed to divert to
noninstitutional programs children and adolescents at risk of
involvement with traditional mental health institutions.
5673. (a) A five-year pilot program is hereby authorized in Napa
County and Riverside County to establish a 15-bed locked facility in
each county, for the provision of community care and treatment for
mentally disordered persons who are placed in a state hospital or
another health facility because no community placements are available
to meet the needs of these patients. It is the intent of the
Legislature to carefully evaluate this specific approach to determine
its potential for replication in other limited jurisdictions.
Participation in this pilot program by the two counties shall be on a
voluntary basis. The pilot program shall be implemented
notwithstanding the following licensure requirements enforced by the
State Department of Social Services:
(1) Subdivision (a) of Section 1502 of the Health and Safety Code,
which defines a community care facility as providing nonmedical
care.
(2) Subdivision (a) of Section 1505 of the Health and Safety Code,
which exempts any health facility, as defined by Section 1250 of the
Health and Safety Code, from licensure under the California
Community Care Facilities Act (Chapter 3 (commencing with Section
1500) of Division 2 of the Health and Safety Code).
(3) Section 1507 of the Health and Safety Code, which limits the
provision of medical services in community care facilities to
incidental medical services.
(4) Paragraph (5) of subdivision (a) of Section 80001 of Title 22
of the California Code of Regulations, which states that an adult
residential facility provides nonmedical care.
(5) Paragraph (7) of subdivision (a) of Section 80072 of Title 22
of the California Code of Regulations, which relates to a client's
right not to be locked in any room, building, or facility premises.
However, for purposes of this section, a client shall not be locked
in any room.
(b) Clients provided care within these pilot facilities shall be
conservatees as defined by Section 5350 who, prior to the
establishment of this program, either received care at a state
hospital or were placed in facilities for the mentally disordered.
(c) Standards for services provided shall be developed by each
county mental health director, in consultation with, and approved by,
the State Department of Mental Health and monitored regularly by the
department for compliance with these standards. These services shall
be on a 24-hour basis in a therapeutic homelike environment. The
services shall cover the full range of the social rehabilitation
model concept, including, but not limited to, the following:
(1) Counseling.
(2) Day treatment.
(3) Crisis intervention.
(4) Vocational training.
(5) Medication evaluation and management by a licensed physician
and other licensed professional and paraprofessional staff who
possess a valid license or certificate to perform this function.
(d) Administration of medication and monitoring of medication
shall occur notwithstanding statutory and regulatory licensure
requirements for community care facilities to the contrary. Standards
for use of medications shall be developed and monitored by the State
Department of Mental Health.
(e) The facilities shall be licensed and monitored by the State
Department of Social Services and shall comply with all licensing
requirements except those specifically exempted by this section. In
addition, no less than 75 square feet of outdoor space per client
shall be made available for client use. The State Department of
Social Services shall conduct inspections of the facilities pursuant
to Section 1533 of the Health and Safety Code and shall be given
immediate access to the facilities.
(f) In staffing the pilot program, each county board of
supervisors shall give full consideration to each potential means of
implementation, including, but not limited to, the clinical,
programmatic, and economic benefits and advantages of each
alternative. The pilot program shall meet all of the staffing
criteria of subdivision (b) of Section 5670.5. The staff shall use
and document the actions of a multidisciplinary professional
consultation staff to meet the specific diagnostic and treatment
needs of clients. The staff shall include, but need not be limited
to, a licensed psychiatrist, a psychologist, a social worker, and a
psychiatric technician. The staff may also include a licensed
vocational nurse. One or more of the following licensed professionals
shall be present at the facility at all times:
(1) A psychiatrist or psychologist.
(2) A registered psychiatric nurse.
(3) A psychiatric technician.
(4) A licensed vocational nurse.
(g) Protocols and training shall be established for licensed
vocational nurses employed by these facilities.
(h) The State Department of Mental Health shall certify the
program content in each county and monitor the program's functions on
a regular basis and the State Department of Social Services shall
regularly evaluate the facilities in accord with its statutory and
regulatory licensure functions, pursuant to subdivisions (d) and (e).
(i) The pilot program shall be deemed successful if it
demonstrates both of the following:
(1) That costs of the program are no greater than public
expenditures for providing alternative services to the clients served
by the program.
(2) That the benefit to the clients, as described in subdivision
(h), is improved by the program.
(j) Commencement of the pilot program in each county pursuant to
this section shall be contingent upon the county and the department
identifying funds for this purpose, as described in a financial plan
that is approved in advance by the Department of Finance.
5675. (a) Subject to Section 5768, Placer County and up to 15 other
counties may establish a pilot project for up to six years, to
develop a shared mental health rehabilitation center for the
provision of community care and treatment for persons with mental
disorders who are placed in a state hospital or another health
facility because no community placements are available to meet the
needs of these patients. Participation in this pilot project by the
counties shall be on a voluntary basis.
(b) (1) The department shall establish, by emergency regulation,
the standards for the pilot project, and monitor the compliance of
the counties with those standards. Participating counties, in
consultation with the department, shall be responsible for program
monitoring.
(2) The department, in conjunction with the county mental health
directors, shall provide an interim report to the Legislature within
three years of the commencement of operation of the facilities
authorized pursuant to this section regarding the progress and cost
effectiveness demonstrated by the pilot project. The department, in
conjunction with the county mental health directors, shall report to
the Legislature within five years of the commencement of operation of
the facilities authorized pursuant to this section regarding the
progress and cost effectiveness demonstrated by the pilot project.
The report shall evaluate whether the pilot project is effective
based on clinical indicators, and is successful in preventing future
placement of its clients in state hospitals or other long-term health
facilities, and shall report whether the cost of care in the pilot
facilities is less than the cost of care in state hospitals or in
other long-term health facility options. The evaluation report shall
include, but not be limited to, an evaluation of the selected method
and the effectiveness of the pilot project staffing, and an analysis
of the effectiveness of the pilot project at meeting all of the
following objectives:
(A) That the clients placed in the facilities show improved global
assessment scores, as measured by preadmission and postadmission
tests.
(B) That the clients placed in the facilities demonstrate improved
functional behavior as measured by preadmission and postadmission
tests.
(C) That the clients placed in the facilities have reduced
medication levels as determined by comparison of preadmission and
postadmission records.
(3) The pilot project shall be deemed successful if it
demonstrates both of the following:
(A) The costs of the program are no greater than public
expenditures for providing alternative services to the clients served
by the project.
(B) That the benefit to the clients, as described in this
subdivision, is improved by the project.
(c) The project shall be subject to existing regulations of the
State Department of Health Services applicable to health facilities
that the State Department of Mental Health deems necessary for fire
and life safety of persons with mental illness.
(d) The department shall consider projects proposed by other
counties under Section 5768.
(e) (1) Clients served by the project shall have all of the
protections and rights guaranteed to mental health patients pursuant
to the following provisions of law:
(A) Part 1 (commencing with Section 5000) and this part.
(B) Article 5 (commencing with Section 835), Article 5.5
(commencing with Section 850), and Article 6 (commencing with Section
860) of Chapter 4 of Title 9 of the California Code of Regulations.
(2) Clients shall have access to the services of a county patients'
rights advocates as provided in Chapter 6.2 (commencing with Section
5500) of Part 1.
5675.1. (a) In accordance with subdivision (b), the department may
establish a system for the imposition of prompt and effective civil
sanctions for long-term care facilities licensed or certified by the
department, including facilities licensed under the provisions of
Sections 5675 and 5768, and including facilities certified as
providing a special treatment program under Sections 72443 to 72474,
inclusive, of Title 22 of the California Code of Regulations.
(b) If the department determines that there is or has been a
failure, in a substantial manner, on the part of any such facility to
comply with the applicable laws and regulations, the director may
impose the following sanctions:
(1) A plan of corrective action that addresses all failure
identified by the department and includes timelines for correction.
(2) A facility that is issued a plan of corrective action, and
that fails to comply with the plan and repeats the deficiency, may be
subject to immediate suspension of its license or certification,
until the deficiency is corrected, when failure to comply with the
plan of correction may cause a health or safety risk to residents.
(c) The department may also establish procedures for the appeal of
an administrative action taken pursuant to this section, including a
plan of corrective action or a suspension of license or
certification.
5675.2. (a) There is hereby created in the State Treasury the
Licensing and Certification Fund, Mental Health, from which money,
upon appropriation by the Legislature in the Budget Act, shall be
expended by the State Department of Mental Health to fund
administrative and other activities in support of the department's
Licensing and Certification Program.
(b) Commencing January 1, 2005, each new and renewal application
for a license to operate a mental health rehabilitation center shall
be accompanied by an application or renewal fee.
(c) The amount of the fees shall be determined and collected by
the State Department of Mental Health, but the total amount of the
fees collected shall not exceed the actual costs of licensure and
regulation of the centers, including, but not limited to, the costs
of processing the application, inspection costs, and other related
costs.
(d) Each license or renewal issued pursuant to this chapter shall
expire 12 months from the date of issuance. Application for renewal
of the license shall be accompanied by the necessary fee and shall be
filed with the department at least 30 days prior to the expiration
date. Failure to file a timely renewal may result in expiration of
the license.
(e) License and renewal fees collected pursuant to this section
shall be deposited into the Licensing and Certification Fund, Mental
Health.
(f) Fees collected by the department pursuant to this section
shall be expended by the department for the purpose of ensuring the
health and safety of all individuals providing care and supervision
by licensees and to support activities of the Licensing and
Certification Program, including, but not limited to, monitoring
facilities for compliance with applicable laws and regulations.
(g) The department may make additional charges to the facilities
if additional visits are required to ensure that corrective action is
taken by the licensee.
5676. (a) The department, in conjunction with the State Department
of Health Services, shall develop a state-level plan for a
streamlined and consolidated evaluation and monitoring program for
the review of skilled nursing facilities with special treatment
programs. The plan shall provide for consolidated reviews, reports,
and penalties for these facilities. The plan shall include the cost
of, and a timeline for implementing, the plan. The plan shall be
developed in consultation with stakeholders, including county mental
health programs, consumers, family members of persons residing in
long-term care facilities who have serious mental illness, and
long-term care providers. The plan shall review resident safety and
quality programming, ensure that long-term care facilities engaged
primarily in diagnosis, treatment, and care of persons with mental
diseases are available and appropriately evaluated, and ensure that
strong linkages are built to local communities and other treatment
resources for residents and their families. The plan shall be
submitted to the Legislature on or before March 1, 2001.
(b) The State Department of Health Services shall forward to the
State Department of Mental Health copies of citations issued to a
skilled nursing facility that has a special treatment program
certified by the State Department of Mental Health.
5676.5. (a) It is the intent of the Legislature to ensure that
funds allocated to establish or enhance mental health programs are
used to integrate the new or enhanced program into an existing system
of care.
(b) Counties that apply for funds to establish or enhance their
mental health service system shall document, in the application
process, how the new funds blend into an existing system of care and
do not supplant existing expenditures.
(c) Applications shall include plans for services and supports,
and shall specify how the new or enhanced program blends into an
existing array of services. Applications shall demonstrate how a
collaborative process involving clients, family members, and other
system stakeholders was used to develop the proposal.
(d) Applications shall include a commitment to outcome reporting,
as defined by the department, including client benefit outcomes,
client and family member satisfaction, system of care access, cost
savings, cost avoidance, and cost effectiveness outcomes that measure
both short- and long-term cost savings.
(e) Applications shall demonstrate, when appropriate, how the
county intends to continue the new or enhanced program when the grant
funds have ended.
